Stress in the Neonatal Intensive Care Unit (NICU)

Stressful events – a byproduct of life for babies in the NICU – may increase their heart rate and blood pressure, while decreasing their oxygen levels.([FOOTNOTE=Peng N-H, Bachman J, Jenkins R, et al. Relationships between environmental stressors and stress biobehavioral responses of preterm infants in NICU. J Perinat Neonatal Nurs. 2009;23(4):363-371.],[ANCHOR=],[LINK=]) Even sensory and environmental stimuli we take for granted, such as a simple touch and noise and bright lights, can affect physiologic responses such as heart rate, respiration, and oxygen saturation1,([FOOTNOTE=Smith JR. Comforting touch in the very preterm hospitalized infant: an integrative review. Adv Neonatal Care. 2012;12(6):349-365.],[ANCHOR=],[LINK=])

The additive impact of multiple stressors over time may have profound long-term consequences on the lives of NICU babies.([FOOTNOTE=Newnham CA, Inder TE, Milgrom J. Measuring preterm cumulative stressors within the NICU: the Neonatal Infant Stressor Scale. Early Hum Dev. 2009;85(9):549-555.],[ANCHOR=],[LINK=]) In the rapidly developing perinatal brain, repeated neonatal stress may have long-term effects on the central nervous system,3 including effects on neural structure, function, and development.3,([FOOTNOTE=Smith BA, Gutovich J, Smyser MD, et al. Neonatal intensive care unit stress is associated with brain development in preterm infants. Ann Neurol. 2011;70(4):541-549.],[ANCHOR=],[LINK=])

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The Types of NICU Stressors


Neonatal stress may have long-term effects on the physiological systems of fragile, preterm infants that may affect their development.3

What you can do to reduce stress in the NICU

  • Ventilation - delivering synchronized breath, with both invasive and non-invasive ventilation, can have important benefits for neonates.([FOOTNOTE=Mahmoud RA, Proquitté H, Fawzy N, Bührer C, Schmalisch G. Tracheal tube airleak in clinical practice and impact on tidal volume measurement in ventilated neo¬nates. Pediatr Crit Care Med. 2011;12(2):197-202]],[ANCHOR=],[LINK=])
  • Patient monitoring - providing continuous SpO2, pulse rate, and respiration rate monitoring, so clinicians may detect respiratory complications earlier and intervene sooner.([FOOTNOTE=Joint Commission Sentinel Event Alert: Issue #49, pp1-4, August 8, 2012. (Available at],[ANCHOR=],[LINK=]),([FOOTNOTE=ASA Standards for Basic Anesthetic Monitoring, Committee of Origin: Standards and Practice Parameters (Approved by the ASA House of Delegates on October 21, 1986, and last amended on October 20, 2010 with an effective date of July 1, 2011, excerpt from section 3.2.4.],[ANCHOR=],[LINK=]),([FOOTNOTE=Essential Monitoring Strategies to Detect Clinically Significant Drug-Induced Respira¬tory Depression in the Postoperative Period. Prepared by Stoelting, R. and Overdyk, F.],[ANCHOR=],[LINK=])
  • Procedural stress - reducing any associated pain, discomfort, or risk of infection may help.

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